EACH tooth has a dental pulp commonly called “nerve” by patients, and this is the control centre. The anatomy of the pulp is well-known to dentists. Individual teeth have divisions of the pulp called root canals. Each tooth has one to four root canals. When these small pieces of soft tissue die or become injured or infected, the resulting pain can be as debilitating as almost any other physical condition experienced by humans.

Why does a piece of diseased or dead tissue cause pain? A tooth is usually sealed externally by the outside tooth coating (enamel). Only a small opening into the supporting bone is present on the tooth end, deep within the bone. When a dental pulp is diseased or dead, pulp blood-flow and cellular activity increase, and there is no possibility for the release of pressure from inside the tooth, except into the supporting bone. The result is pain, and it is usually present when a tooth is dead or dying.

Occasionally, the infection finds its way into the bone and perforates out into the soft gum tissue. The patient observes a pimplelike projection on the gums, commonly called a gum boil, and this “dead” tooth is usually not painful.

What clinical conditions are commonly observed related to dead or dying teeth? When chewing on the suspect tooth, significant pain is experienced. Pushing on the tooth or tapping on it with a hard object creates pain. The tooth may have periods of no pain. Antibiotic therapy usually reduces or eliminates the pain for a while.

Pressure pain may indicate a dead or dying tooth, but it may also indicate a cracked tooth or a tooth that has had recent heavy chewing or “bruxing” on it. If your dentist finds a dead or dying tooth, you have the following alternatives: root canal therapy or extraction of the offending tooth.

A red, pimplelike projection on the cheek or tongue side of the tooth near the tooth root end usually indicates that the tooth pulp (nerve ) is dead and the infection has broken through the bone to the outside. This condition creates a fistula or canal from the tooth root end through the gums.

Yellow pus can often be expressed from red projections without much pain, but the pus will return until the therapy is completed. Treatment for the draining fistula may include the following:
A. Endodontic therapy alone.
B. Root canal (endodontic) therapy and an apicoectomy (root-tip amputation and root-tip filling) if the defect in the bone is large.
C. Hemi section (amputation of one or more roots) may be needed, if the disease is especially persistent and involves only one root of a multi-rooted tooth.
D. Extraction of the tooth.

Although over 95% of root canal treatments are successful, a few of these teeth occasionally cause subsequent pain or other problems. After a discussion with your dentist, you will have several alternatives:
A. Redoing the root canal therapy
B. Apicectomy (root amputation and root-tip filling)
C. Hemi section (amputation of one or more roots)
D. Extraction of the tooth.